Laurie Edwards: The Gender Gap in Pain

Laurie Edwards is the author of the forthcoming book “In the Kingdom of the Sick: A Social History of Chronic Illness in America” and a writing teacher at Northeastern University.

TO the list of differences between men and women, we can add one more: the drug-dose gender gap. Doctors and researchers increasingly understand that there can be striking variations in the way men and women respond to drugs, many of which are tested almost exclusively on males. Early this year, for instance, the Food and Drug Administration announced that it was cutting in half the prescribed dose of Ambien for women, who remained drowsy for longer than men after taking the drug.

Women have hormonal cycles, smaller organs, higher body fat composition — all of which are thought to play a role in how drugs affect our bodies. We also have basic differences in gene expression, which can make differences in the way we metabolize drugs. For example, men metabolize caffeine more quickly, while women metabolize certain antibiotics and anxiety medications more quickly. In some cases, drugs work less effectively depending on sex; women are less responsive to anesthesia and ibuprofen for instance. In other cases, women are at more risk for adverse — even lethal — side effects.

These differences are particularly important for the millions of women living with chronic pain. An estimated 25 percent of Americans experience chronic pain, and a disproportionate number of them are women. A review published in the Journal of Pain in 2009 found that women faced a substantially greater risk of developing pain conditions. They are twice as likely to have multiple sclerosis, two to three times more likely to develop rheumatoid arthritis and four times more likely to have chronic fatigue syndrome than men. As a whole, autoimmune diseases, which often include debilitating pain, strike women three times more frequently than men....